Bottom Line:
UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter.Serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin levels and incidence of acute kidney injury did not show significant differences between groups.In cardiac surgery infants, EA produced more UO compared with F on POD0.

Methods: A prospective randomized double-blinded study was conducted. Patients received 0.2 mg/kg/h (up to 0.8 mg/kg/h) of either F or EA.

Results: In total, 38 patients were enrolled in the F group, and 36, in the EA group. No adverse reactions were recorded. UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter. Mean administered F dose was 0.33 (0.19) mg/kg/h compared with 0.22 (0.13) mg/kg/h of EA (P

Conclusions: In cardiac surgery infants, EA produced more UO compared with F on POD0. Generally, a smaller EA dose is required to achieve similar UO than F. EA and F were safe in terms of renal function, but EA caused a more-intense metabolic alkalosis. EA patients achieved better CI, and shorter mechanical ventilation and PCICU admission time.

Fig2: Fluid balance (FB) per kilogram of patient body weight in the three study days in the furosemide (F) and ethacrynic acid (EA) groups. *P < 0.05. POD, postoperative day. Data are expressed as average and standard deviation.

Mentions:
The primary end point (UO at POD0) was 6.9 (3.3) ml/kg/h in the EA group, which was significantly higher than 4.6 (2.3) ml/kg/h (P = 0.002) in the F group. UO in the following days tended to be similar in the two groups, without significant differences (Figure 1A). However, mean diuretic dose was significantly different in the two groups throughout the study period: overall, mean administered furosemide was 0.33 (0.19) mg/kg/h, whereas mean administered EA was 0.22 (0.13) mg/kg/h (P < 0.0001): it can be assumed that for a similar UO, about 30% less EA was needed. A daily diuretic dose above 0.4 mg/kg/h was administered to three patients in the L group (two of these received 0.8 mg/kg/h for 24 hours, and one received 0.5 mg/kg/h for 48 hours) and to one patient in the EA group (0.5 mg/kg/h for 24 hours). The mean UO levels indexed over mean diuretic dose were significantly different in the two groups at every time point (<0.01) (Figure 1B). Fluid balance was significantly more negative in the EA group at POD0: −43 (54) ml/kg/h compared with −17 (32) ml/kg/h (P = 0.01) in the F group. Thereafter, fluid balance was similar in the two groups (Figure 2).Figure 1

Fig2: Fluid balance (FB) per kilogram of patient body weight in the three study days in the furosemide (F) and ethacrynic acid (EA) groups. *P < 0.05. POD, postoperative day. Data are expressed as average and standard deviation.

Mentions:
The primary end point (UO at POD0) was 6.9 (3.3) ml/kg/h in the EA group, which was significantly higher than 4.6 (2.3) ml/kg/h (P = 0.002) in the F group. UO in the following days tended to be similar in the two groups, without significant differences (Figure 1A). However, mean diuretic dose was significantly different in the two groups throughout the study period: overall, mean administered furosemide was 0.33 (0.19) mg/kg/h, whereas mean administered EA was 0.22 (0.13) mg/kg/h (P < 0.0001): it can be assumed that for a similar UO, about 30% less EA was needed. A daily diuretic dose above 0.4 mg/kg/h was administered to three patients in the L group (two of these received 0.8 mg/kg/h for 24 hours, and one received 0.5 mg/kg/h for 48 hours) and to one patient in the EA group (0.5 mg/kg/h for 24 hours). The mean UO levels indexed over mean diuretic dose were significantly different in the two groups at every time point (<0.01) (Figure 1B). Fluid balance was significantly more negative in the EA group at POD0: −43 (54) ml/kg/h compared with −17 (32) ml/kg/h (P = 0.01) in the F group. Thereafter, fluid balance was similar in the two groups (Figure 2).Figure 1

Bottom Line:
UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter.Serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin levels and incidence of acute kidney injury did not show significant differences between groups.In cardiac surgery infants, EA produced more UO compared with F on POD0.

Methods: A prospective randomized double-blinded study was conducted. Patients received 0.2 mg/kg/h (up to 0.8 mg/kg/h) of either F or EA.

Results: In total, 38 patients were enrolled in the F group, and 36, in the EA group. No adverse reactions were recorded. UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter. Mean administered F dose was 0.33 (0.19) mg/kg/h compared with 0.22 (0.13) mg/kg/h of EA (P

Conclusions: In cardiac surgery infants, EA produced more UO compared with F on POD0. Generally, a smaller EA dose is required to achieve similar UO than F. EA and F were safe in terms of renal function, but EA caused a more-intense metabolic alkalosis. EA patients achieved better CI, and shorter mechanical ventilation and PCICU admission time.